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User
Posted 20 May 2020 at 14:13

Hello


Apologies if this has already been asked/explained on the site.........


I have been taking my Dad (age 80) to various prostate related appointments and he showed me a letter from the hospital registrar to his GP saying various things but included that his rectal examination was abnormal and it was T2a.


Because of my job in financial services, I do see quite a bit of health information and assumed it was some type of cancer grading which google shows it is.  But no-one has actually said to my Dad that he has cancer.  If he has, would it be his GP or the hospital who would tell him?  I don't feel it's my place to even mention it and I know he won't google T2a.


He's been called for a bone scan now - have suggested we contact his GP to ask why and I presume it will come up then.


Thank you so much if anyone can help.


 


 


 

User
Posted 20 May 2020 at 14:48

Hi,


If you don't ask I doubt anyone will tell you until they decide for certain after a biopsy.  Although you never know.


You can't really tell from a DRE or a psa test.  It takes a biopsy to confirm it and even they aren't 100%. 


When you have scans and biopsies you're usually out of the GPs hands and it's up to the hospital.   There is a chance he hasn't got it.   


What is his psa score, I suppose you don't know and don't want to ask.


I think I'd try to soften the blow somehow so it's not a complete surprise but leave it as late as possible.  You can say they need to rule it out rather than they think you have.


There are chances it's not but I'd think finding out suddenly might be a worse shock.


I'd already made my mind up that I'd got it although according to stats it was 50/50.   I felt some relief it was found in time and was treatable.


Regards
Peter


 

User
Posted 20 May 2020 at 15:26

To know it's T2a, they've already done the scan, or they might be saying it's at least T2a.


Having got my MDT records back, I can see they try to be careful about letting the patient know, for example a there's a tick box to say cancer has been diagnosed, and another one to say patient has been informed, ideally so someone doesn't let the cat out of the bag until patient gets told properly with support services on hand.


I'm guessing with half the urology department still off dealing with COVID-19 patients, some things are probably not being done by the usual people who know the procedures.


 

User
Posted 20 May 2020 at 16:19

Hi Mrss,
I was referred by my GP to Urology at the local hospital. The first meeting suggested there may be a problem, I had a PSA test and DRE at that meeting. I then received about four letters all on the same day listing appointments for various tests, and one for an appointment at the end, for the results. The whole timescale was about three weeks. I don't know if all hospitals are the same but I would assume that once all tests are done your dad will have an appointment at the hospital for results, and only then will a formal diagnosis be announced.


As I was going through the test diagnosis process, there were hints that I had a problem prior to the formal diagnosis meeting.
So yes take this as a hint that things may not be perfect, but don't start to panic. With the information you have given so far PSA20 and T2a this is probably treatable and curable.


 

Edited by member 20 May 2020 at 16:20  | Reason: Not specified

Dave

User
Posted 20 May 2020 at 16:31
It depends on the exact wording of the letter and also what the various appointments are that you have taken him to but I disagree with the others; the urology department has stated in a letter that he has an abnormal DRE and is T2a so I think they will expect dad to understand that he has prostate cancer. They wouldnt be sending him for a bone scan if they hadn't already diagnosed it and probably assume he will realise that. I agree that it isn't usually the GP who tells someone they have cancer but I would expect the GP to discuss the letter with the patient and ensure they understand the contents.

Does the letter give you any other information? What were the various appointments - any scans?
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 20 May 2020 at 17:54
I was diagnosed with PCa following Biopsy and told it was T2A. I was subsequently given an MRI scan following which it was upgraded from T2A to T3A. Consequently, the surgeon who headed the MDT was not keen to do a RP and personally escorted me to an oncologist a few rooms away with a view to having RT. However, scans do not always reveal the cancer or it's extent so even with all the tools available to them Consultants sometimes are not sure of the extent of the cancer. In these circumstances a template biopsy may be given if not already done. Top urologists advocate MRI before biopsy according to a highly regarded urologist and the template (Transperineal) Biopsy over the TRUS one being not only more accurate but less likely to cause infection albeit a more involved procedure.
Barry
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User
Posted 20 May 2020 at 14:48

Hi,


If you don't ask I doubt anyone will tell you until they decide for certain after a biopsy.  Although you never know.


You can't really tell from a DRE or a psa test.  It takes a biopsy to confirm it and even they aren't 100%. 


When you have scans and biopsies you're usually out of the GPs hands and it's up to the hospital.   There is a chance he hasn't got it.   


What is his psa score, I suppose you don't know and don't want to ask.


I think I'd try to soften the blow somehow so it's not a complete surprise but leave it as late as possible.  You can say they need to rule it out rather than they think you have.


There are chances it's not but I'd think finding out suddenly might be a worse shock.


I'd already made my mind up that I'd got it although according to stats it was 50/50.   I felt some relief it was found in time and was treatable.


Regards
Peter


 

User
Posted 20 May 2020 at 14:58
Peter

Thank you so much - his PSA is 20. He got a call telling him that asking him to go for a kidney scan.

Your message is so helpful. I hope you are doing well.

thanks!
User
Posted 20 May 2020 at 15:26

To know it's T2a, they've already done the scan, or they might be saying it's at least T2a.


Having got my MDT records back, I can see they try to be careful about letting the patient know, for example a there's a tick box to say cancer has been diagnosed, and another one to say patient has been informed, ideally so someone doesn't let the cat out of the bag until patient gets told properly with support services on hand.


I'm guessing with half the urology department still off dealing with COVID-19 patients, some things are probably not being done by the usual people who know the procedures.


 

User
Posted 20 May 2020 at 16:19

Hi Mrss,
I was referred by my GP to Urology at the local hospital. The first meeting suggested there may be a problem, I had a PSA test and DRE at that meeting. I then received about four letters all on the same day listing appointments for various tests, and one for an appointment at the end, for the results. The whole timescale was about three weeks. I don't know if all hospitals are the same but I would assume that once all tests are done your dad will have an appointment at the hospital for results, and only then will a formal diagnosis be announced.


As I was going through the test diagnosis process, there were hints that I had a problem prior to the formal diagnosis meeting.
So yes take this as a hint that things may not be perfect, but don't start to panic. With the information you have given so far PSA20 and T2a this is probably treatable and curable.


 

Edited by member 20 May 2020 at 16:20  | Reason: Not specified

Dave

User
Posted 20 May 2020 at 16:31
It depends on the exact wording of the letter and also what the various appointments are that you have taken him to but I disagree with the others; the urology department has stated in a letter that he has an abnormal DRE and is T2a so I think they will expect dad to understand that he has prostate cancer. They wouldnt be sending him for a bone scan if they hadn't already diagnosed it and probably assume he will realise that. I agree that it isn't usually the GP who tells someone they have cancer but I would expect the GP to discuss the letter with the patient and ensure they understand the contents.

Does the letter give you any other information? What were the various appointments - any scans?
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 20 May 2020 at 17:42

Thank you so much for sharing your knowledge.


This all started because he couldn't pass water and he had a catheter fitted.


He's had a bladder scan and a kidney scan, a try at removing the catheter but he still couldn't pass water so it was reinserted.  There is a talk of permanent Catheter or TURP operation.


The call to book a bone scan was today which is what lead me to here.


 

User
Posted 20 May 2020 at 17:54
I was diagnosed with PCa following Biopsy and told it was T2A. I was subsequently given an MRI scan following which it was upgraded from T2A to T3A. Consequently, the surgeon who headed the MDT was not keen to do a RP and personally escorted me to an oncologist a few rooms away with a view to having RT. However, scans do not always reveal the cancer or it's extent so even with all the tools available to them Consultants sometimes are not sure of the extent of the cancer. In these circumstances a template biopsy may be given if not already done. Top urologists advocate MRI before biopsy according to a highly regarded urologist and the template (Transperineal) Biopsy over the TRUS one being not only more accurate but less likely to cause infection albeit a more involved procedure.
Barry
User
Posted 20 May 2020 at 18:53

Hi,


If you've been taking him to all the appointments there are differences you may have noticed.   The DRE appointment might have only taken 15 minutes and been in Urology.   An MRI would last around an hour in Radiology.  A biopsy would take around 30 minutes in Urology.  The Bone Scan would be in a branch of Radiology, Nuclear Testing, or something, about 40 minutes with an injection 4 hours earlier.  The injection needle is so thin you don't even notice it.


Mine was hard on one side and T2a, although the MRI said it was risk of T3.  After the op they cut it up and said it's T2a.


Are you sure you aren't both keeping things from each other.  He might know and not want to say specifically.  Although you might be able to tell whether that's the case.


T2a isn't that bad although at 80 he's likely to be offered Radiotherapy as long as his bone scan is alright.   An op at that age, lying sloping head down for 3hrs is regarded too risky for the vast majority.  At that age people often die of something else before Prostate Cancer gets them.  If that's not too morbid but there are a lot of treatments.


All the best, Peter

Edited by member 20 May 2020 at 18:55  | Reason: Not specified

User
Posted 20 May 2020 at 20:20
As Lyn noted, a bone scan is the final step in the diagnostic process. You get one when you've been diagnosed with prostate cancer, and they want to check whether or not it's spread elsewhere in the body. Before getting to this stage, he must have had at minimum an MRI scan and almost certainly a biopsy too!

Best wishes,

Chris
User
Posted 20 May 2020 at 22:13

Originally Posted by: Online Community Member


At that age people often die of something else before Prostate Cancer gets them.  If that's not too morbid



I did want to include a sentence like that in my earlier post, but couldn't quite find the right words. Everything in life is a balance of risk and rewards, and the only certainty is death (and taxes). Your dad needs to think about his general level of health, and how much he wants to put his body through. My aunt was in her 90s and had an operation for breast cancer, she then lived to 93 and died of a heart attack. I really don't know if it is worth going through an operation for another three years in the nursing home. Of course now a day's 80 is not very old, and the figures we know about your dad are likely curable, but there are people on here who decline treatment in order to enjoy what remains of their life without the side effects of treatment. Dad will have to think about that, when the diagnosis and treatment options are known. 

Dave

User
Posted 20 May 2020 at 22:23

Agreed - my father-in-law was diagnosed at the age of 79 and refused radical treatment because he was worried about how it would affect his sex life. He died 4 years later but a month before he died, he went camping in France & Italy for a month - he was only really ill for the last 2 or 3 days of his life.


Worth also noting that 80% of men in their 80s have some prostate cancer even though most will never be diagnosed, let alone have treatment.

Edited by member 21 May 2020 at 10:12  | Reason: Not specified

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 20 May 2020 at 22:25

Originally Posted by: Online Community Member
As Lyn noted, a bone scan is the final step in the diagnostic process. You get one when you've been diagnosed with prostate cancer, and they want to check whether or not it's spread elsewhere in the body. Before getting to this stage, he must have had at minimum an MRI scan and almost certainly a biopsy too!

Best wishes,

Chris


 


Unless the DRE was unequivocal and there is a medical reason that he can't have MRI? 

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 21 May 2020 at 08:16
But they couldn't have come up with a "T2A" staging from just a DRE, surely?

Cheers,

Chris
User
Posted 21 May 2020 at 10:13
That's why I asked about the precise wording on the letter - I wondered if it said something equivocal such as 'assumed to be T2a' or 'may be at least T2a'

It is also possible that they could see the tumour bulging in the urethra when they did the bladder scan?
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 21 May 2020 at 13:53

I can't thank you all enough for your really helpful replies.  


Right or wrong, I am very stoical about it all.  Having seen relatives decline in nursing homes for years, I would never wish that on anyone.


Although I've taken him to the appointment, I haven't actually gone in because of the virus.  I'm going to take another look at the letter when I take his shopping over at the weekend and contact the consultant to just check he will co-ordinate the plan going forward once tests are all complete.   


Thank you again x 

 
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